OUR TA

The Milliman team consists of actuaries, healthcare consultants, and analysts with decades of experience in healthcare finance, payment policy and direct experience working within Massachusetts and with MassHealth ACOs, with Medicaid programs, and with providers participating with Delivery System Reform Incentive Payment Programs. For example, Milliman’s Senior Consulting Actuaries and Senior Management Consultants in San Francisco and New York bring strong technical knowledge on the details of designing, developing, and supporting implementation of alternative payment models, population health management programs, and managed care strategies. Rate development and analysis are at the core of what Milliman offers, where staff routinely model alternative payment model arrangements and provide strategic consulting regarding developing payment models that align incentives with the goals of value-based and alternative payment contracts.

WHAT MAKES THIS VENDOR UNIQUE

  • Milliman is one of the world’s largest independent consulting firms with over 60 years of experience in analytics, healthcare actuarial services, and healthcare management consulting services, and we are recognized as one of the leading healthcare consulting firms throughout the United States, with offices in New York, San Francisco and multiple locations throughout the country.
  • Quantitative analytics are at the core of Milliman’s consulting where staff maintains benchmarking and analytic databases that include healthcare claims data for over 65 million lives.
  • As a firm, our health practice invests millions of dollars annually to enhance databases and produce studies that are used by health plans and providers, public agencies, and policymakers to inform program design.

A SUCCESSFUL TA EXPERIENCE

Milliman’s services include: providing data warehousing and analytics; creating algorithms to identify and classify high-risk patients; assisting in managing costs/revenue under value-based contracts; creating utilization benchmarks to help the client understand areas of opportunity for cost reduction and services redirection inside the ACO; and calculating ROI for value-based contracts. To carry out this TA we receive and process data from a number of payers, have a data warehouse platform for clients, apply algorithms to payer data, recommend clinical interventions for specific health conditions, and estimate savings from managing high-risk patients. Milliman’s assistance allows the ACO to understand its population better, prioritize members for interventions and care management, and understand the impact that population health management and value-based payment arrangements would have on their bottom line.

 

The statements in this document are made solely by Milliman. No statement in this document should be construed as an official position of or endorsement by Abt Associates Inc. or the Massachusetts Executive Office of Health and Human Services.

ABOUT MILLIMAN

Milliman is an independent firm that delivers market-leading services and solutions to clients worldwide whose mission is to serve our clients to protect the health and financial well-being of people everywhere. For over 70 years, a team of professionals ranging from actuaries to clinicians, technology specialists to plan administrators, have given unparalleled expertise in employee benefits, investment consulting, healthcare, life insurance and financial services, and property and casualty insurance. The Milliman team has experience in healthcare finance, payment policy and direct experience working within Massachusetts, with Medicaid programs, and with providers participating with Delivery System Reform Incentive Payment Programs to assist private and public partners with design, implementation, and evaluation of healthcare programs, as well as with stewardship of finite budgets. Milliman is committed to partnering with entities that finance, manage, or deliver healthcare services.

ORGANIZATION FUN FACTS

  • Milliman has a wide variety of professionals ranging from actuaries to clinicians, technology specialists and plan administrators.
  • Our research in the areas of retirement, healthcare and risk management is regularly mentioned in the press and has been cited by the United States Congress and the U.S. Supreme Court.

QUOTES FROM CLIENTS

“Milliman was able to explain what all the various methods are for building reinsurance and stop-loss programs for our ACO. With the expertise we received from Milliman, we were able to make decisions about how to structure internal and external stop loss and reinsurance programs. This was a critically important step in developing a plan to manage the downside risk of our new MassHealth ACO.” – Community Care Cooperative
“Milliman was able to provide training and expertise in understanding how MassHealth established the Network Variance Factor (NVF) within our benchmark. After learning about the details of MassHealth’s NVF methodology from Milliman, our ACO’s management team was able to educate our Finance Committee about the details of the NVF. We used the information to better understand our benchmark and better plan for managing our Total Cost of Care.” – Community Care Cooperative

DOMAINS:

Actuarial and Financial

Care Coordination/Integration

Community-Based Care and Social Determinants of Health

Consumer Engagement

Flexible Services

Health Information Technology (HIT)

Performance Improvement

Population Health Management

Workforce